NPI | 1780834390 |
---|---|
Other Name | PSYCH, INC |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AL 1723) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
103T00000X Psychologist (Licence: KY 1732) | |
Enumeration Date | 2008-09-19 |
Last Update Date | 2021-06-29 |